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Tough job

September 23, 2011

Although Germany has plenty of doctors, there's a shortage of general practitioners willing to work in rural areas. The government wants to help with financial incentives, but money is only part of the problem.

A tractor in a field in Brandenburg
Distances are greater, but people are closer in the countryImage: picture-alliance/ZB

Dr. Sebastian Dannehl carefully packs his black doctor's bag before heading out on a house call. Out here in the countryside of the eastern German state of Brandenburg he has to make long drives to reach his patients so he can't forget anything. He even packs an electronic chip card reader for the patients' health insurance cards. Nine months ago the 39-year-old moved to the town of Fürstenberg an der Havel to be the area's general practitioner.

Doctor's bag and a stethoscope
Country doctors have to bring everything with them on their house callsImage: fotolia/Elnur

"I have to go to one of the neighboring villages to check on an older man who's been having problems with dizziness," he says as heads out of his practice.

In a normal day of work Dannehl does the kinds of things his medical colleagues in the big cities have little interest in.

It's a time-intensive job that doesn't pay a whole lot. Fewer and fewer doctors want to work out in the countryside like Dannehl does. There are already 550 empty rural practices in Germany. In the next ten years another 7,000 practices will join them, as country doctors retire without replacements.

Hidden shortage

Despite the hours spent in the car and the high price of gas, Dannehl says he knows he's needed out here.

"You have to make these house calls," he says. "People are getting older and more helpless, even more so in the countryside. There are pensioners here, people who are struggling, people on welfare, and often they have problems with alcohol."

Making things even more difficult, in a region like this there aren't many wealthy private patients who, in the city, can make a practice profitable.

Older hands on a cane
As the population ages, the need for these doctors increasesImage: BilderBox

On paper, there are plenty of doctors in Germany. The number of practicing physicians has increased in the last 20 years by 50 percent. But there's a "but," according to Udo Wolter, the president of the Brandenburg Chamber of Country Doctors.

"The training of general practitioners has been neglected in recent years and the young doctors stay in the cities where they studied," he says.

Wolter is hopeful that a new government initiative meant to things easier for country doctors and give them financial incentives to work in rural areas could make the being a country doctor more attractive for new physicians. He warns, however, that he's seen similar programs fail to have an effect in the past. "It's not all about the money," he says.

'Everyone knows everyone'

Dannehl agrees. Country life, he says, is a major turn-off for many.

"Maybe they can't stand how close and familiar everyone is with each other, because in the city you have anonymity. You can't have that here," he says. "People watch every step you take here. Everyone knows where you live. When you go to a party, everyone knows everyone. You have to talk to everyone. You can't hide in anonymity."

And then there's the lack of cultural and education opportunities. As Dannehl arrives in the village where his patient lives, he looks out at the simple houses. A torn poster advertises an AC/DC cover band. He takes the second right and rolls up to his destination: a detached family house.

A different choice

Dannehl has made this drive to visit this particular patient several times over the last few days. But today when he called, no one answered. Dannehl is worried. No one comes to the door, so he walks in. "Hello?" he calls into the house.

He finds the man in bed. The patient greets the doctor with a weak wave.

Dr. Sebastian Dannehl
So far, life in the country suits Dr. DannehlImage: DW/Kiesel

"This dizziness, I’m seeing everything double," the man says, "and I always have such a headache."

Dannehl takes the man's pulse and then checks his medical records again. There's not much he can do, but he doesn't want to just leave the sick man. So he picks up the telephone. The patient will go to hospital for observation.

Back in his practice in Fürstenberg he calculates his charges for the visit: 21 euros ($28) for the house call and 15 euros for the trip. The whole thing took about an hour. He could earn money more quickly and easily in the city, but he's consciously chosen a different path. Here in the countryside he knows he is needed.

"I really like living and working here. In the end I feel very comfortable here, and that's something money can't buy," he says. "What makes someone happy? Health, a good environment, friends, and acceptance. Money? Well, yeah, a little bit."

Author: Heiner Kiesel / hf
Editor: Rob Turner